Provider Demographics
NPI:1124358163
Name:CRAVCHIK, ANIBAL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANIBAL
Middle Name:
Last Name:CRAVCHIK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GRANGE HALL DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4310
Mailing Address - Country:US
Mailing Address - Phone:301-458-0131
Mailing Address - Fax:
Practice Address - Street 1:604 S FREDERICK AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1275
Practice Address - Country:US
Practice Address - Phone:301-458-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00691852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3330231 00Medicaid
MD3330231 00Medicaid